Case Study: Management of Type 2 Diabetes After Bariatric Surgery

112 Volume 25, number 3, 2007 • CliniCal Diabetes PreSentation J.B. is a morbidly obese man with a medical history significant for type 2 diabetes diagnosed at 40 years of age and combined hyperlipidemia with severe hypertriglyceridemia. His diabetes was originally treated with oral agents for ~ 4 years. Subsequently, his glycemic control worsened, and his hemoglobin A 1c (A1C) ranged between 10 and 12%. During this time, he was also diagnosed with hypertension and obstructive sleep apnea. After hospitalization for mild diabetic ketoacidosis at 44 years of age, he was started on insulin therapy. At that time, he weighed 264 lb, and his BMI was 37 kg/m. During the next 2 years, J.B. required increasing doses of insulin and, because of his significant insulin resistance, was switched to the more concentrated U500 regular insulin formulation. With this therapy, his A1C decreased to 200 mg/dl, and he had lost 37.4 lb. Over the next 4 months, he lost 103.4 lb, and his insulin sensitivity continued to improve. He was gradually weaned off insulin therapy. One year after surgery, J.B. had lost 143 lb, and his A1C was 6.6% only taking metformin, 500 mg twice daily. His hypertriglyceridemia had also improved. Preoperatively, he was treated with fenofibrate and atorvastatin, and his triglycerides ranged from 400 to 1,200 mg/dl. One year after surgery, off medications, his triglycerides had decreased to 150–300 mg/dl, secondary to weight loss alone.